Reporting Global Health Epidemics In A Wired World

In China, a new form of avian flu, called H7N9, has killed 10 people and infected an additional 28. China’s gotten plaudits from the global health community for its transparency and responsiveness to this outbreak. But that's partly because many remember how China lied about SARS in 2002, a decision that killed hundreds. Public health reporter Maryn McKenna talks to Bob about what the standards are for reporting health epidemics in a wired world.

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Transcript

BOB GARFIELD: On March 31st, China announced that a new form of bird flu, catchally named H7N9, had infected a handful of humans, mostly in Shanghai. China has been updating the infection and casualty rates regularly. As of Friday, 10 people have died and an additional 28 are infected. China's responsiveness has earned it plaudits from the global health community, which remembers another public health crisis that originated in China in 2002 and went much, much differently.

MARYN McKENNA: Web-crawling programs picked up some chatter in Chinese, but when this was brought by the World Health Organization to the Chinese government, the Chinese governments said, no, we’re really just having a bad flu season. We've got it under control. That's Maryn McKenna, an independent public health journalist. She says that in the few months in 2002 that the Chinese government avidly denied it had a problem, more than 500 people died and what we now know as SARS spread. Then, in February 2003, China's denial was undone, and a global pandemic was narrowly averted, all because of one post on a listserv used by American public health officials and amateur virologists called ProMED-mail.

MARYN McKENNA: There was a note on ProMED-mail that came from a guy who was a former Navy physician and epidemiologist, now operating a sort of private consultancy in retirement in Baltimore. The night before he'd gotten a note from his former next-door neighbor in Hawaii, a woman who was a fourth grade teacher, now living in California, and that fourth grade teacher was friends on a chat room with a guy who represented himself as a teacher in Southern China. And on that night before he had said in this chat room, “Have you heard that there is a terrible illness in my city? The hospitals are full and people are dying.” So this woman forwarded the note to her former neighbor, who sent it on to this email list operated out of Harvard. ProMED-mail. And, in very short order, the Chinese government said, yes, we do have something going on that is not quite a normal flu season. And from there, the world was alerted that SARS was happening.

BOB GARFIELD: Now, in the meantime, many infected people had crossed borders. The disease was spreading. And, apart from the public health consequences, China had a tremendous loss of face. How did the embarrassment attached to SARS change the way the world tracks and reports illnesses?

MARYN McKENNA: Up to that point, the world had relied on the governments of individual countries to tell the rest of the world whenever anything of concern was going on. Going forward from SARS, the World Health Organization accepted that unofficial sources of information could be as useful, if not more useful, in alerting the world to disease threats. And they actually put that into the international regulations by which health is governed around the world.

BOB GARFIELD: This compact was signed by 193 countries, but no single country is obliged to do anything, right?

MARYN McKENNA: This is the sticking point. The World Health Organization and the governments that back it up, those 193 governments and what's called the World Health Assembly, don't really have much power to compel any one government to do anything. The most they can do is persuade.

BOB GARFIELD: Which brings up the subject of Saudi Arabia, which has been apparently less than forthcoming with a, a viral outbreak of its own, something called coronavirus. Tell me about that.

MARYN McKENNA: It's really interesting that both of these are happening at the same time because this novel coronavirus that has been causing illness now in the Middle East since last summer, is a distant relative of SARS. To our knowledge, there have not been that many cases yet, but the flow of information around this coronavirus is not as good as the flow of information is around the new flu H7N9. So it does show that not every country is responding to this implicit demand for transparency around the world.

BOB GARFIELD: [LAUGHS] Does it also not sure that if you're going to have a fallback system based on scouring the web for mentions of disease in a country where there isn't much Internet penetration and a whole lot of censorship, such a backup plan might not work very well?

MARYN McKENNA: I think we like to think now that information will out sooner or later, but it may be that the international health regulations post-SARS that rely on other sources of information can’t solve every problem around the channels through which information flows.

BOB GARFIELD: Well, actually, I have another kind of good news/bad news thing. It turns out in the case of H7N9, the first reports were not harvested from the kind of social voluntary grid but from the Chinese government itself. On the other hand [LAUGHING], Maryn, I’ve read that the government has actually arrested people for overstating the number of infections and deaths. Which China are we witnessing here?

MARYN McKENNA: I don't know what the content was in those Weibo posts that got people incarcerated. Of course, as somebody with Western standards of free expression, I would not want to see that happen.

At the same time, when I think of some of the Twitter posts I've seen, in English and other languages, over the past 72 hours, I certainly don't approve of the authoritarian impulse, but I can understand where it comes from.

BOB GARFIELD: Well, well, well, give me an example of a Tweet posted makes you want to throw [LAUGHS] someone into the clink?

How irresponsible is some of this Weibo tweeting?

MARYN McKENNA: Before this all started, there was an apparently separate problem with huge die offs of pigs, thousands been found in the rivers.

BOB GARFIELD: Oh, in the rivers, yeah.

MARYN McKENNA: Right. The best speculation at this point seems to be that that is not, in fact, related to the flu, but it was a natural response. So the next speculation was oh, look, we have photos on Weibo of sparrows falling from trees in a particular city, surely the flu killed them, as well. And I think after that there was a fish die-off. Over about 72 hours there was a sort of unified field theory of flu [LAUGHS]

[BOB LAUGHS]

- in which flu was killing everything. And, you know, flu doesn't always kill everything. [LAUGHS] There's a saying that medical students learn, probably in their first year, and medical reporters and public health reporters, like myself, would do well to remember. “When you hear hoof beats, think horses, not zebras” –

[BOB CHUCKLES]

- that the problem with reporting on scary diseases, and especially with social media chatter about scary diseases, is that we always go first to the zebra. And sometimes it is a zebra; sometimes it's SARS. But sometimes it's just a horse.

BOB GARFIELD: Maryn, thank you very much.

MARYN McKENNA: Thank you for having me.

BOB GARFIELD: Maryn McKenna is an independent public health reporter and author of, Beating Back the Devil: On the Frontlines with the Disease Detectives of the Epidemic Intelligence Service.

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